Dear Dr. Gottlieb: My daughter is 19, and I have been a single mother for 10 years. My ex-husband has struggled with substance abuse for most of his life and recently left several treatment facilities before completing their programs. He is now on track.
My daughter was very involved with her father throughout his treatment. She began to attend Al-Anon meetings, and for this I was grateful. I had never elaborated on the seriousness of his addictions, and this was a real eye-opener for her.
At about the same time, my daughter’s first “real” boyfriend broke up with her. She was devastated. She wanted to see a professional, and I agreed it was a good idea. She found a clinical social worker and liked the woman from the start. However, after only two or three visits, the therapist told my daughter she didn’t need to come every week.
Then she said my daughter is clinically depressed and needs a prescription for Paxil. Now this has become an issue between us. I want my daughter to get a second opinion. Her therapist basically says, “I can’t believe an educated woman such as your mother could be so unenlightened and would object to her 19-year-old daughter taking antidepressants.”
There is addiction on both sides of the family. Alcoholism, heroin, speed. I don’t object to medication for serious depression, but my daughter is doing well in college; she also has a good part-time job, friends, and a life. Unless she is telling the therapist something I don’t know, I am inclined to believe that talk therapy and Al-Anon meetings are worth a shot. And I don’t think it could be a mistake to seek a second opinion.
Can you share your thoughts?
Dear reader: You are right to be concerned. Over the last five years, according to the U.S. Agency for Healthcare Research and Quality, the use of antidepressants among young people has increased 62 percent. Although no one can fully explain this dramatic increase, I believe there are a combination of factors at work:
Our children are getting more stressed and depressed.
With more efficient drugs, medical and mental-health professionals are probably prescribing them too liberally.
Managed care more readily reimburses less expensive pills over more expensive therapy.
Our culture is moving toward faster and more mechanical solutions for emotional problems.
We must be cautious before we medicate a young person. Two or three sessions with a 19-year-old who is apparently functioning well are not enough to make that diagnosis and recommendation. Your daughter might have a major depression. She also could be grieving a loss, having an identity crisis, reacting to trauma, or responding to many other things.
If your daughter had a significant disturbance in eating or sleeping, or if she were suicidal, there would be more of a rush to prescribe. But it seems to me this can wait a few weeks, or even a few months, so you can see if talk therapy helps.
And even if she does require medication, research shows that a combination of medication and psychotherapy is most effective in treating depression. So I’m confused why someone would recommend medication and at the same time cut back on psychotherapy, unless your daughter’s social worker is following health-insurance restrictions. My final concern is about a therapist not welcoming a second opinion. Generally, a second opinion only helps the patient.
I thought I would practice what I preach and get a second opinion. I spoke with Jack Gitterman, a psychiatrist in Abington. He agreed that this kind of treatment should start with talk therapy. “Although I have seen antidepressants save many lives and marriages, they are still drugs, and they have side effects,” he said. “Talk therapy has no side effects and is often the first choice.”
On another concern of yours, he said there was no evidence the drugs are physically addictive.
So now that I’ve given you all this support, let me address the other side. If your daughter were 15, I would insist on getting a second opinion, with an eye on finding a new therapist. Assuming her depression is not consuming, I would lean toward a trial of talk therapy first. And I would look for a therapist who welcomed your input.
But your daughter is not 15. She is 19 and has more control over her life. If she does not want a second opinion, you might suggest that she get one later if she does not do well with the medication. Meanwhile, it is important that you support her efforts to get care for her depression. Please also tell her you will be supportive, no matter what her decision.
And there is another issue: Much of the input you have received about the social worker has come from your daughter. We don’t know whether this is what the social worker is actually saying or whether your daughter has distorted some things in order to keep you on the outside of the process – or has just misinterpreted things. Perhaps – remembering that she is 19 and that you must respect her boundaries – you could get your daughter’s permission to join her in a session so that everyone could express her feelings directly.
I still think the final decision should be your daughter’s. After all, there is a real possibility the social worker is right: Your daughter may, in fact, be clinically depressed and could be helped by medication.